Provider Demographics
NPI:1467955633
Name:MQH HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:MQH HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-206-4365
Mailing Address - Street 1:6577 N BRAEBURN LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3323
Mailing Address - Country:US
Mailing Address - Phone:414-206-4365
Mailing Address - Fax:414-206-0871
Practice Address - Street 1:6577 N BRAEBURN LN
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-3323
Practice Address - Country:US
Practice Address - Phone:414-206-4365
Practice Address - Fax:414-206-0871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100069346Medicaid